Systems, methods, and computer readable storage media storing instructions for generating an image integrating functional, physiological and anatomical images

ABSTRACT

Systems, methods and computer-readable storage mediums relate to generating an image that includes functional, anatomical, and physiological images. The generated image may be an integrated image based on the functional image on which the anatomical and physiological images are mapped. The generated image may indicate more than one location of optimal lead placement. The generated image may be useful in pre-planning cardiac intervention procedures.

CROSS REFERENCE TO RELATED APPLICATION

This application claims priority to U.S. Provisional Application Ser.No. 61/587,150 filed on Jan. 17, 2012, which is hereby incorporated bythis reference in its entirety.

ACKNOWLEDGEMENT

This invention was made with government support under Grant No.RR025008, awarded by the National Institutes of Health. The governmenthas certain rights in the invention.

BACKGROUND

Heart failure remains a major concern in developed countries. About 5.7million people in the U.S. have heart failure, and it results in about3000,000 deaths each year. One treatment option for patients withsymptomatic heart failure (HF) resulting from systolic dysfunction iscardiac resynchronization therapy (CRT). CRT is achieved bysimultaneously pacing both the left and right ventricles in asynchronized manner. Numerous clinical investigations have demonstratedthat CRT may improve clinical status, functional capacity, and survivalin select patients with ventricular dyssynchrony.

Despite the success of cardiac resynchronization therapy shown inseveral international, multicenter, placebo controlled clinical trials,one out of three patients undergoing CRT will not positively respond tothe therapy. Two potential reasons for a patient's non-response to CRTare: 1) poor selection criteria or 2) non-optimalimplementation/application of the biventricular pacing device. Asignificant amount of work has been done to use imaging to addressselection of candidates for CRT. However, much less has been done tooptimize device performance by selecting and planning lead positions onthe myocardium. To achieve the highest physiological and mechanicalefficiency and maximize the benefit of CRT, one would like to place theleft ventricular (LV) pacing lead at the location of the most delayedcontraction that is not predominately scar tissue. Retrospective studieshave shown that if the LV lead is located at the “most dyssynchronous”or “latest contracting” region, response rates are improved.

SUMMARY

However, it has been difficult to implement this strategy in aprospective fashion to guide LV lead placement because preoperativeimaging does not routinely provide information about coronary venousanatomy and scar burden with respect to the area of latest delayedcontraction. Thus, there is need for planning of optimal lead placementlocation before the CRT procedure.

This disclosure relates to systems, methods, and computer readablestorage mediums storing instructions for generating an image thatincludes functional, physiological and anatomical images of a heart of apatient, and an integrated image. In some embodiments, the generatedimage may include images of contraction timing, myocardial scardistribution, and coronary vein anatomy. The image may indicate at leastone optimal lead location. The contraction timing may be LV contractiontiming. The optimal lead location may be the region of latestcontraction that is not in an area of significant scar. Thus, thesystems, methods and computer-readable storage mediums according toembodiments may improve patient response rate to CRT.

In some embodiments, the generated image may be an integrated image map.In some embodiments, the generated image may include at least one of theanatomical and physiological images mapped to the functional image. Thegenerated image may include a functional image on which the anatomicaland physiological images overlap. The anatomical image may includecardiac anatomy, such as coronary vein images. The physiological imagemay include regions of myocardial scar, such as regions that havesuffered a previous heart attack. The functional image may includecontraction timing. The functional image may include a contractiontiming map that identifies areas of dyssynchrony.

In some embodiments, a method may include: processing a plurality ofsets of image data of a heart, each set of image data being different;and generating an image of the heart including functional, anatomical,and physiological images. The method may also include receiving imagedata.

In some embodiments, the image data may include magnetic resonance (MR)image data. The image data may include a plurality of images acquiredfrom a magnetic resonance imaging (MRI) scan. The image data may be in aDigital Imaging and Communications in Medicine (DICOM) format. The imagedata may include a header and image data. The header may include imageinformation. The image information may include information regarding thescan. The image information may include but is not limited to number offrames, dimensions of the image, data resolution, and image size.

In some embodiments, the image data may include more than one set ofimage data. In some embodiments, the image data may include at least twosets of image data. In some embodiments, the image data may include cineimage data and contrast image data. The contrast image data may includewhole-heart vascular image data acquired during contrast administrationand post-contrast image data of muscle of the heart.

In some embodiments, the functional image may be generated from the cineimage data. The anatomical and physiological images may be generatedfrom the post-contrast image data. The image data may be acquired fromcine MRI. The post-contrast image data may be acquired from acontrast-enhanced sequence. The cine image data may include high framecine image data acquired over a cardiac cycle. The post-contrast imagedata may be post Gadolinium enhancement image data.

In some embodiments, the image data may include at least two sequencesof data. In some embodiments, the sequences may include a steady-statefree precession (SSFP) sequence and a contrast-enhanced sequence. Thecine image data may be acquired from the SSFP sequence. Thecontrast-enhanced sequence may be a 3D whole-heart contrast-enhancedsequence.

In some embodiments, the image data may include functional, anatomical,and physiological image data. In other embodiments, the image data mayinclude functional, anatomical, and physiological images.

In some embodiments, the processing the image data may include mappingthe anatomical and physiological images to the functional image.

In some embodiments, the processing the image data may includeprocessing the image data to generate the functional, anatomical andphysiological images. In some embodiments, the processing the image datamay further include processing a first portion of the image data togenerate the functional images. The first portion of the image data mayinclude the cine image data. The processing to generate the functionalimages may include identifying borders of the heart of the patient attime points and locations in the heart. The borders may be between heartmuscle (myocardium) and blood pool of the heart of the patient. Theprocessing may further include determining movement of the borders as afunction of time for each location in the heart. The time may be thepeak of the motion. The determining may be based on a cross-correlationdelay. The processing may further include generating a timing map thatidentifies areas of dyssynchrony. The timing map may be an AHA17-segment map on which time is plotted.

In some embodiments, the processing the image data may further includeprocessing a second portion of the image data to generate the anatomicalimage. The second portion may include the data acquired from acontrast-enhanced sequence. The data may include a plurality of images.The images may include coronary vein images. The processing to generatethe anatomical image may include identifying anatomy of the heart on theimages. The anatomy may include coronary veins. The identifying mayinclude identifying a position of each vein on the heart on the images.In some embodiments, the processing may include reconstructing thecoronary veins in a 3D space. The method may further include mapping theposition of each coronary vein to the functional image or dyssynchronymap.

In some embodiments, the processing the image data may further includeprocessing a third portion of the image data to generate thephysiological image. The third portion may include the data acquiredfrom a contrast-enhanced administration. The third portion may includepost-contrast image data. The data may include a plurality of images.The images may include images of cardiac muscle of the patient. Theprocessing to generate the physiological image may include identifyingregions of the cardiac muscle. The regions may be brighter than otherregions of the cardiac muscle. The regions may correspond to scar tissueor regions that have suffered a previous myocardial infarction or heartattack. The method may further include mapping the position of eachmyocardial infarction to the functional image or dyssynchrony map.

In some embodiments, the generated image may include markers identifyinglocations of optimal lead placement. The generated image may becolor-coded. The generated image may include at least one location ofoptimal lead placement. In some embodiments, the generated image mayinclude three locations of optimal lead placement. Optimal leadplacement may correspond to locations that AHA segment that has latestcontraction that does not contain a transmural scar.

In some embodiments, the method may further include displaying thegenerated image. The method may further include transmitting thegenerated image to an interventional system. The method may furtherinclude displaying a position of an interventional device within theheart on the generated image.

In some embodiments, a method may include processing physiological,anatomical, and functional images; and generating an image that includesthe physiological, anatomical and functional images. The integratedimage may be based on the functional image onto which the physiologicaland anatomical images are mapped. The generated image may include afunctional image on which the anatomical and physiological imagesoverlap. The anatomical images may include cardiac anatomy, such as veinimages. The physiological images may include regions of myocardial scar,such as regions that have suffered a previous heart attack. Thefunctional image may include a timing map that identifies areas ofdyssynchrony.

In some embodiments, a computer-readable storage medium storinginstructions for generating an image that includes functional,physiological and anatomical images, the instructions may includereceiving image data; processing the image data; and generating an imageincluding the functional, anatomical, and physiological images. In otherembodiments, the instructions may include receiving functional,anatomical, and physiological images; and generating an integrated imageincluding the functional, anatomical, and physiological images.

In some embodiments, a system for generating an integrated image mayinclude an apparatus that includes at least one processor and at leastone memory including computer code. The at least one memory and thecomputer program code configured to, with the at least one processor,may cause the apparatus to perform at least the following: receivingimage data; processing the image data; and generating an image includingfunctional, anatomical, and physiological images.

In some embodiments, a generated image may include physiological,anatomical, and functional images. The generated image may be based onthe functional image. The generated image may be based on the functionalimage onto which the physiological and anatomical images are mapped.

Additional advantages of the disclosure will be set forth in part in thedescription which follows, and in part will be obvious from thedescription, or may be learned by practice of the disclosure. Theadvantages of the disclosure will be realized and attained by means ofthe elements and combinations particularly pointed out in the appendedclaims. It is to be understood that both the foregoing generaldescription and the following detailed description are exemplary andexplanatory only and are not restrictive of the disclosure, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure can be better understood with the reference to thefollowing drawings and description. The components in the figures arenot necessarily to scale, emphasis being placed upon illustrating theprinciples of the disclosure.

FIG. 1 illustrates an example of a CRT device implanted in a heart of apatient.

FIG. 2 illustrates a method of generating an image including functional,anatomical, and physiological images, according to embodiments.

FIG. 3 illustrates steps of generating the image according toembodiments.

FIG. 4 illustrates an example of processing image data to generate afunctional image.

FIG. 5 illustrates an example of processing image data to generate animage including functional, anatomical, and physiological images,according to embodiments.

FIG. 6 shows an example of a system according to embodiments.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The following description, numerous specific details are set forth suchas examples of specific components, devices, methods, etc., in order toprovide a thorough understanding of embodiments of the disclosure. Itwill be apparent, however, to one skilled in the art that these specificdetails need not be employed to practice embodiments of the disclosure.In other instances, well-known materials or methods have not beendescribed in detail in order to avoid unnecessarily obscuringembodiments of the disclosure. While the disclosure is susceptible tovarious modifications and alternative forms, specific embodimentsthereof are shown by way of example in the drawings and will herein bedescribed in detail. It should be understood, however, that there is nointent to limit the disclosure to the particular forms disclosed, but onthe contrary, the disclosure is to cover all modifications, equivalents,and alternatives falling within the spirit and scope of the disclosure.

The disclosure relates to systems, computer-readable storage mediums,and methods for generating an image that includes functional,anatomical, and physiological images. The generated image may be animage capable of being displayed as a single unified display of thetiming of the regional contraction, regional scar, and images of thecoronary veins. In some embodiments, the generated image may be anintegrated map including the functional, anatomical, and physiologicalimages.

The generated image is described with respect to planning of an optimallead placement location before a CRT procedure, such as an implantationof a CRT pacing device (e.g., a biventricular pacemaker or a combinationof a CRT and implantable cardiac defibrillator (ICD) device). An exampleof a CRT device implanted in a heart of a patient is shown in FIG. 1. Asshown in FIG. 1, a CRT device 100 may include a pulse generator 110 thathouses a battery and a computer connected to leads. The CRT device mayinclude 2-3 leads positioned in the right atrium, right ventricle andleft ventricle (via the coronary sinus vein). The device 100 shown inFIG. 1 includes leads 120, 130, 140 positioned in the right atrium,right ventricle and left ventricle, respectively. However, it should beunderstood that the disclosure is not limited to preplanning a CRTprocedure and may be used other purposes. For example, the disclosuremay be used in other medical intervention procedures planning, such as,for example, atrial fibrillation procedure planning, or atrial flutterprocedure planning.

As used herein, optimal lead placement may be the location of the mostdelayed contraction that is not predominately or does not contain scartissue (an area of a previous heart attack). Optimal lead placement mayalso be referred to as “most dyssynchronous” or “latest contracting”region or location.

Methods & Generated Images

The methods of the disclosure are not limited to the steps describedherein. The steps may be individually modified or omitted, as well asadditional steps may be added.

Unless stated otherwise as apparent from the following discussion, itwill be appreciated that terms such as “identifying,” “receiving,”“integrating,” “filtering,” “combining,” “reconstructing,” “segmenting,”“generating,” “registering,” “determining,” “obtaining,” “processing,”“computing,” “selecting,” “estimating,” “detecting,” “tracking,” or thelike may refer to the actions and processes of a computer system, orsimilar electronic computing device, that manipulates and transformsdata represented as physical (e.g., electronic) quantities within thecomputer system's registers and memories into other data similarlyrepresented as physical quantities within the computer system memoriesor registers or other such information storage, transmission or displaydevices. Embodiments of the methods described herein may be implementedusing computer software. If written in a programming language conformingto a recognized standard, sequences of instructions designed toimplement the methods may be compiled for execution on a variety ofhardware platforms and for interface to a variety of operating systems.In addition, embodiments are not described with reference to anyparticular programming language. It will be appreciated that a varietyof programming languages may be used to implement embodiments of thedisclosure.

FIG. 2 illustrates a method according to embodiments to generate animage including functional, anatomical, and physiological images of aheart of a patient. In some embodiments, a method 200 may include a step210 of receiving image data. The image data may be of a heart of apatient.

In some embodiments, the image data may include magnetic resonance (MR)image data. The image data may include a plurality of images acquiredfrom a magnetic resonance imaging (MRI) scan. The image data may be in aDigital Imaging and Communications in Medicine (DICOM) format. The imagedata may include header and image data. The header may include imageinformation. The image information may include information regarding thescan. The image information may include but is not limited to number offrames, dimensions of the image, data resolution, image size, or acombination thereof.

In some embodiments, the image data may include more than one set ofimage data. In some embodiments, the image data may include at least twosets of image data. In some embodiments, the image data may include atleast three sets of different image data. In some embodiments, the imagedata may include at least cine image data and contrast image data. Thecontrast image data may include whole-heart vascular image data acquiredduring contrast administration and post-contrast image data of muscle ofthe heart.

In some embodiments, the cine image data may be acquired from asteady-state free precession sequence. The post-contrast image data maybe acquired from a contrast-enhanced sequence. The cine image data mayinclude high frame cine image data acquired over a cardiac cycle. Thepost-contrast image data may be post Gadolinium enhancement image data.

In some embodiments, the image data may include at least two sequencesof data. In some embodiments, the sequences may include a steady-statefree precession (SSFP) sequence and a contrast-enhanced sequence. Thecine image data may be acquired from the SSFP sequence. In someembodiments, the cine image data may be acquired in short axisorientation using a SSFP sequence and a temporal resolution of 60 framesper cycle. The contours may be re-sampled at 360 equally spaced radialspokes per slice. The contrast-enhanced sequence may be a 3D whole-heartcontrast-enhanced sequence.

In other embodiments, the image data may include at least one offunctional, physiological, and anatomical images of a heart of apatient. The functional image may be an image that includes contractiontiming. The functional image may be a dyssynchrony map. In someembodiments, the physiological image may be an image that includesregional scar distribution. The physiological image may be a map. Theanatomical image may be an image that includes coronary veins of theheart.

In some embodiments, the method may further include a step 220 ofprocessing the image data. In some embodiments, the processing the imagedata may include processing the image data to generate functional,physiological and anatomical images. In some embodiments, the functionalimage may be generated from the cine image data. The anatomical andphysiological images may be generated from the post-contrast image data.

In other embodiments, the processing step 220 the image data may beomitted. The receiving step 210 may include receiving functional,physiological and anatomical images. It should also be understood thatthe processing steps may be performed in any order and are not limitedto the order discussed below.

In some embodiments, the processing step 220 the image data may furtherinclude processing a first portion of the image data or a first set ofimage data to generate the functional image. In some embodiments, thefirst portion or first set may include the cine image data. Thefunctional image may be based on a stack of cine images.

In some embodiments, the functional image may be a dyssynchrony map. Insome embodiments, the distance of the points on the contours from thecenter of mass of the LV may provide radial displacement curves for eachof the 360 points along the contour of each slice. In some embodiments,the functional image may be generated automatically. In otherembodiments, the generation of the functional image may include manualsteps.

In some embodiments, processing to generate the functional image mayinclude identifying borders of the heart on each image. The borders maybe between the myocardium and the blood pool over the time points andall locations in the heart. The movement of these borders may bedetermined as a function of time for each location in the heart. Thetime of the peak of the motion may be identified with a mathematicalfunction (e.g., a cross-correlation delay) and the time may be plottedon a map (AHA 17-segment map). The map may be a timing map thatidentifies areas of dyssynchrony (also referred to as a dyssynchronymap).

FIG. 4 show an example of the processing of the image data to generate afunctional image. The borders may include endocardial borders. Each ofthe borders may be sampled radially, as shown in the left image of FIG.4. From each radial position, radial displacement may be computed. Insome embodiments, the mechanical activation delay from each the globalvalue for each location may be determined using a cross-correlationanalysis, as shown in the center image of FIG. 4. Next, the delay timesfor each location may be plotted on a bullseye map, as shown in theright image of FIG. 4. Each of these steps may be performedautomatically and/or manually.

In some embodiments, the processing step may further include processinga second portion of the image data or second set of image data togenerate an anatomical image. In some embodiments, the second portion orsecond set may include the data acquired from the contrast-enhancedsequence. In some embodiments, the contrast may be a gadolinium contrastagent. The contrast-enhanced sequence may be a 3D whole-heartcontrast-enhanced sequence. In some embodiments, the data may beacquired using an imaging protocol in which a 3D whole-heartcontrast-enhanced sequence during which a 0.2 mmol/kg of a gadoliniumcontrast agent is infused at 0.03 cc/sec to produce a long plateau ofmaximum contrast agent concentration in the blood and allow for morek-space data to be acquired during maximum contrast concentration. Thedata may include a plurality of images. The images may include coronaryvein images and the anatomy may be coronary veins.

In some embodiments, the processing to generate the anatomical image mayinclude identifying anatomy of the heart on the images. The identifyingmay include identifying a position of coronary vein on the heart on eachof the images. In some embodiments, the processing may includereconstructing the coronary veins in a 3D space.

In some embodiments, the step 220 of processing the image data mayfurther include processing a third portion of the image data or thirdset of image data to generate the physiological image. The physiologicalimage may be an image or map of regional scar distribution. The map maybe the same type of map as the functional image. The third portion orset may include the data acquired from a contrast-enhancedadministration. The third portion or set may include post-contrast imagedata. The data may include a plurality of images. The images may includeimages of cardiac muscle of the patient. The physiological image may bebased on echo images. In some embodiments, the echo image may beinversion recovery prepared, segmented, and gradient echo images.

In some embodiments, the processing to generate the physiological imagemay include identifying regions of the cardiac muscle. The regions maybe brighter than other regions of the cardiac muscle. The regions maycorrespond to scar tissue or regions that have suffered a previousmyocardial infarction or heart attack. In some embodiments, the regionsof the cardiac muscle may include the endocardial, epicardial andinfarct borders of the heart.

In some embodiments, based on the borders, the transmularity of infarctmay be determined. In some embodiments, from the identified borders,radial spokes may be drawn through the myocardium from the center of themass outward. The transmularity of infarct along each spoke may bedetermined by the thickness of the infarct divided by the totalendocardial-to-epicardial distance. In some embodiments, 360° spokes maybe used to display transmularity within each given slice. Each of thesesteps may be performed automatically and/or manually.

In some embodiments, the method may further include a step of 230 ofgenerating at least one image that includes functional, physiologicaland anatomical images. In some embodiments, the generated image mayinclude images of LV contraction timing, myocardial scar distribution,and coronary vein anatomy. The generated image may indicate at least oneoptimal lead location. The optimal lead location may be the region oflatest contraction that is not in an area of significant scar.

In some embodiments, the generated image may be an integrated image map.In some embodiments, the generated image may include the anatomical andphysiological images mapped to the functional image. The generated imagemay include a functional image on which the anatomical and physiologicalimages overlap. The anatomical images may include cardiac anatomy, suchas vein images. The physiological images may include regions ofmyocardial scar, such as regions that have suffered a previous heartattack. The functional image may include a timing map that identifiesareas of dyssynchrony.

FIG. 3 illustrates steps to generate an image including functional,physiological, and anatomical images. In some embodiments, the steps ofgenerating an image may occur sequentially after each type of image isreceived and/or processed. In some embodiments, the steps 310, 320, and340 of obtaining images may include only receiving the image. In otherembodiments, the steps 310, 320, and 340 of obtaining may furtherinclude other steps. In some embodiments, the steps 310, 320 and 340 mayoccur after each and/or all of the images are processed.

It should be also understood that the steps of generating are notlimited to the order illustrated in FIG. 3 and may occur in a differentorder. For example, the images may be received and mapped in any order.The steps of generating may occur simultaneously, sequentially, orcombination thereof. The steps of generating may also occursimultaneously, sequentially, or combination thereof with other steps ofthe disclosure.

In some embodiments, the step 300 of generating the image may includethe step of 310 of obtaining the functional image and step of 320 ofobtaining the anatomical image. The images may be obtained, for example,by generating functional and anatomical images as discussed above and/orreceiving generated images. The step 300 of generating the image mayfurther include a step 330 of mapping the anatomical image to thefunctional image.

In some embodiments, the step 300 may further include a step 340 ofobtaining a physiological image and a step 350 of mapping thephysiological image to the functional image. The images may be obtained,for example, by generating functional and anatomical images as discussedabove and/or receiving generated images.

An example of a generated image map may be found in FIG. 5. As shown inFIG. 5, an image 540 may be generated based on a physiological image510, a functional image 520, and an anatomical image 530. The image 540may be a dyssynchrony map onto which the physiological image 510 and theanatomical image 530 are mapped.

In some embodiments, the method 200 may include a step 240 ofdetermining at least one location of optimal lead placement. In someembodiments, the step 240 may occur before, during, and or after thestep 230. The step 240 may determine at least one region of latestcontraction(s) that is not in an area of significant scar.

In some embodiments, more than one location of optimal lead placementmay be determined. Any number of locations may be determined. In someembodiments, the determining may include identifying the at least onelocation of optimal lead placement on the generated image.

In some embodiments, the generated image may indicate at least onelocation of optimal lead placement. In some embodiments, the generatedimage may include more than one location of optimal lead placement. Thegenerated image may include any number of optimal lead placements. Insome embodiments, the generated image may include at least threelocations of optimal lead placement.

In some embodiments, the generated image may include at least one markeridentifying each location of optimal lead placement. The marker may beany symbol. As shown in FIG. 5, the marker may be a star. In someembodiments, the generated image and/or at least one optimal lead imagemay be color-coded.

In some embodiments, the generated image may further include a positionof an interventional device within the heart. The interventional devicemay be, for example, any device used for cardiac interventionprocedures. The interventional device may include but is not limited toa probe, a catheter, and an ablation device.

In some embodiments, the method 200 may further include a step 250 ofoutputting the image. In some embodiments, the outputting may includeprinting the generated image. In other embodiments, the outputting mayinclude storing the generated image.

In some embodiments, the outputting may include displaying the generatedimage. In some embodiments, the method may further include displaying atleast one parameter related to a region or location of the generatedimage. The parameter may relate to anatomical, functional, and/orphysiological features of the heart. The parameter may include but isnot limited to diameter of the coronary sinus, the path length of thecoronary sinus, the viewing of the significant branches of the coronarysinus, the quantification of the curvature, and the quantification ofthe degree of obstruction, the degree of transmularity, and thecontraction time. The region may be selected by the operator or may bedisplayed based on a position of an interventional device.

In some embodiments, the outputting may further include transmitting thegenerated image to another system. In some embodiments, the method mayfurther include transmitting the generated image to an interventionalsystem. The interventional system may be any known system configured forcardiac intervention procedures. The method may further includedetermining a position of an interventional device of a heart withrespect to the image, displaying a position of an interventional devicewithin the heart on the generated image, or a combination thereof. Themethod may further include displaying specific parameters of a selectedregion of the heart.

In some embodiments, the generated image may be used for planning acardiac interventional procedure, such as implanting a CRT device.

System Implementation

FIG. 6 shows an example of a system 600 that may be used to generate anintegrated image according to embodiments. The system 600 may includeany number of modules that communicate with other through electrical ordata connections (not shown). In some embodiments, the modules may beconnected via a wired network, wireless network, or combination thereof.In some embodiments, the networks may be encrypted. In some embodiments,the wired network may be, but is not limited to, a local area network,such as Ethernet, or wide area network. In some embodiments, thewireless network may be, but is not limited to, any one of a wirelesswide area network, a wireless local area network, a Bluetooth network, aradio frequency network, or another similarly functioning wirelessnetwork.

Although the modules of the system are shown as being directlyconnected, the modules may be indirectly connected to one or more of theother modules of the system. In some embodiments, a module may be onlydirectly connected to one or more of the other modules of the system.

It is also to be understood that the system may omit any of the modulesillustrated and/or may include additional modules not shown. It is alsobe understood that more than one module may be part of the systemalthough one of each module is illustrated in the system. It is furtherto be understood that each of the plurality of modules may be differentor may be the same. It is also to be understood that the modules mayomit any of the components illustrated and/or may include additionalcomponent(s) not shown.

In some embodiments, the modules provided within the system may be timesynchronized. In further embodiments, the system may be timesynchronized with other systems, such as those systems that may be onthe medical facility network.

The system 600 may include an image acquisition device 610 configured toacquire the image data of a patient. The image acquisition device 610may be any device configured to acquire images from a magnetic resonanceimaging (MRI) scan.

The system 600 may further include a computer system 620 to carry outthe image processing and generating. The computer system 620 may furtherbe used to control the operation of the system or a computer separatesystem may be included.

The computer system 620 may also be connected to another computer systemas well as a wired or wireless network. The computer system 620 mayreceive or obtain the image data from the image acquisition device 610or from another module, such as a hospital server provided on a network.

The computer system 620 may include a number of modules that communicatewith each other through electrical and/or data connections (not shown).Data connections may be direct wired links or may be fiber opticconnections or wireless communications links or the like. The computersystem 620 may also be connected to permanent or back-up memory storage,a network, or may communicate with a separate system control through alink (not shown). The modules may include a CPU 622, a memory 624, animage processor 626, an input device 628, and a printer interface 632.

The CPU 622 may any known central processing unit, a processor, or amicroprocessor. The CPU 622 may be coupled directly or indirectly tomemory elements. The memory 624 may include random access memory (RAM),read only memory (ROM), disk drive, tape drive, etc., or a combinationsthereof. The memory may also include a frame buffer for storing imagedata arrays.

The present disclosure may be implemented as a routine that is stored inmemory 624 and executed by the CPU 622. As such, the computer system 620may be a general purpose computer system that becomes a specific purposecomputer system when executing the routine of the disclosure.

The computer system 620 may also include an operating system and microinstruction code. The various processes and functions described hereinmay either be part of the micro instruction code or part of theapplication program or routine (or combination thereof) that is executedvia the operating system. In addition, various other peripheral devices630 may be connected to the computer platform such as an additional datastorage device, a printing device, and I/O devices.

The image processor 626 may be any known central processing unit, aprocessor, or a microprocessor. In some embodiments, the image processoralso processes the data. In other embodiments, the image processor 626may be replaced by image processing functionality on the CPU 622.

The input device 628 may include a mouse, joystick, keyboard, trackball, touch activated screen, light wand, voice control, or any similaror equivalent input device, and may be used for interactive geometryprescription. The input device 628 may control the peripheral device630.

The peripheral device 630 may include but is not limited to a display,printer device, storage device, as well as other I/O devices. Thedisplay and the printer may be any known display screen and any knownprinter, respectively, either locally or network connected. In someembodiments, the input device 628 may control the production and displayof images on a display, and printing of the images via the printerinterface 632.

In some embodiments, the image processor 626 may be configured totransform the data (through Fourier transformation or another technique)from the image acquisition device 610 into image data. In someembodiments, the image processor 626 may be configured to process theimage data to generate the functional, physiological, and anatomicalimages. The image data may then be stored in the memory 624. In otherembodiments, another computer system may assume the image reconstructionor other functions of the image processor 626. In response to commandsreceived from the input device 628, the image data stored in the memory624 may be archived in long term storage or may be further processed bythe image processor 626 and presented on the display 630.

In some embodiments, the system 600 may include at least oneinterventional device system 640. The interventional device system 640may at least include an interventional device 644. The interventionaldevice may include any device used for cardiac intervention procedures.The interventional device may include but is not limited to a probe, acatheter, and an ablation device. The interventional device system 640may further include at least a display 644 on which the interventionaldevice 642 may be displayed on the generated image. The interventionaldevice system 640 may also include a computer system like computersystem 620.

It is to be understood that the embodiments of the disclosure beimplemented in various forms of hardware, software, firmware, specialpurpose processes, or a combination thereof. In one embodiment, thedisclosure may be implemented in software as an application programtangible embodied on a computer readable program storage device. Theapplication program may be uploaded to, and executed by, a machinecomprising any suitable architecture. The system and method of thepresent disclosure may be implemented in the form of a softwareapplication running on a computer system, for example, a mainframe,personal computer (PC), handheld computer, server, etc. The softwareapplication may be stored on a recording media locally accessible by thecomputer system and accessible via a hard wired or wireless connectionto a network, for example, a local area network, or the Internet.

It is to be further understood that, because some of the constituentsystem components and method steps depicted in the accompanying figurescan be implemented in software, the actual connections between thesystems components (or the process steps) may differ depending upon themanner in which the disclosure is programmed. Given the teachings of thedisclosure provided herein, one of ordinary skill in the related artwill be able to contemplate these and similar implementations orconfigurations of the disclosure.

While the disclosure has been described in detail with reference toexemplary embodiments, those skilled in the art will appreciate thatvarious modifications and substitutions may be made thereto withoutdeparting from the spirit and scope of the disclosure as set forth inthe appended claims. For example, elements and/or features of differentexemplary embodiments may be combined with each other and/or substitutedfor each other within the scope of this disclosure and appended claims.

What is claimed is:
 1. A method for generating an image includingfunctional, anatomical, and physiological images of a heart of apatient, comprising: processing a plurality of sets of magneticresonance (MR) image data of a heart to generate a functional image, ananatomical image, and a physiological image of the heart, the pluralityof sets of MR image data including a set of cine image data and one ormore sets of contrast-enhanced image data, the functional image beinggenerated from the set of cine image data and being a contraction timingmap that includes contraction timing and identifies areas ofdyssynchrony, and the physiological image and the anatomical image beinggenerated from the one or more sets of contrast-enhanced image data, thephysiological image including regional scar distribution; generating anintegrated image of the heart, the integrated image includingfunctional, anatomical, and physiological images, the integrated imagebeing based on the functional image on which the anatomical andphysiological images are mapped; determining one or more optimal leadplacement locations for one or more leads of an implantable device; andidentifying the one or more optimal lead placement locations on theintegrated image.
 2. The method of claim 1, wherein the processingincludes: processing the set of cine image data to generate thefunctional image; processing a first set of contrast-enhanced image datato generate the physiological image; and processing a second set ofcontrast-enhanced image data to generate the anatomical image.
 3. Themethod of claim 1, wherein the anatomical image includes coronary veins.4. The method of claim 1, wherein: the functional image is adyssynchrony map; an the integrated image is an integrated map thatincludes the functional, anatomical, and physiological images, and theintegrated map is based on the functional image on which the anatomicaland physiological images overlap.
 5. The method of claim 1, furthercomprising: displaying a position of an interventional device on theintegrated image.
 6. The method according to claim 1, wherein one ormore optimal lead placement locations are determined based on thecontraction timing and the scar distribution.
 7. The method according toclaim 6, wherein each optimal lead placement location corresponds to aregion of latest contraction that is not an area of significant scar. 8.The method according to claim 1, further comprising: displaying theintegrated image, wherein each of the one or more optimal lead placementlocations is identified on the integrated image by a marker.
 9. Themethod according to claim 1, wherein the contraction timing is of a leftventricle (LV) of the heart.
 10. The method according to claim 1,wherein the processing the cine image data to generate the functionalimage includes determining movement of borders of the heart as afunction of time for each location in the heart.
 11. The methodaccording to claim 10, wherein the borders include endocardial bordersof the heart.
 12. The method according to claim 1, wherein: theanatomical image includes anatomy of the heart, and the anatomy of theheart includes coronary veins, and the mapping the anatomical image tothe functional image includes mapping a position of each coronary veinto the functional image.
 13. A non-transitory computer-readable storagemedium storing instructions for generating functional, physiological andanatomical images of a heart of a patient, the instructions comprising:processing a plurality of sets of magnetic resonance (MR) image data ofa heart to generate a functional image, an anatomical image, and aphysiological image of the heart, the plurality of sets of MR image dataincluding a set of cine image data and one or more sets ofcontrast-enhanced image data, the functional image being generated fromthe set of cine image data and being a contraction timing map thatincludes contraction timing and identifies areas of dyssynchrony, andthe physiological image and the anatomical image being generated fromthe one or more sets of contrast-enhanced image data, the physiologicalimage including regional scar distribution; generating an integratedimage of a heart, the integrated image including the functional,anatomical, and physiological images, the integrated image being basedon the functional image on which the anatomical and physiological imagesare mapped; determining one or more optimal lead placement locations forone or more leads of an implantable device; and identifying the one ormore optimal lead placement locations on the integrated image.
 14. Thenon-transitory computer-readable storage medium of claim 13, wherein theanatomical image includes coronary veins.
 15. The non-transitorycomputer-readable storage medium of claim 13, wherein one or moreoptimal lead placement locations are determined based on the contractiontiming and the scar distribution.
 16. The non-transitorycomputer-readable storage medium of claim 15, wherein each optimal leadplacement location corresponds to a region of latest contraction that isnot an area of significant scar.
 17. The non-transitorycomputer-readable storage medium of claim 13, further comprising:displaying the integrated image, wherein each of the one or more optimallead placement locations is identified on the integrated image by amarker.
 18. The non-transitory computer-readable storage medium of claim13, wherein the contraction timing is of a left ventricle (LV) of theheart.
 19. The non-transitory computer-readable storage medium of claim13, wherein the processing the cine image data to generate thefunctional image includes determining movement of borders of the heartas a function of time for each location in the heart.
 20. Thenon-transitory computer-readable storage medium of claim 13, wherein:the anatomical image includes anatomy of the heart, and the anatomy ofthe heart includes coronary veins, and the mapping the anatomical imageto the functional image includes mapping a position of each coronaryvein to the functional image.